SARS-CoV-2 mRNA Vaccine Breakthrough Infections in Fully Vaccinated Healthcare Personnel: A Systematic Review

The number of people vaccinated against COVID-19 increases worldwide every day; however, it is important to study the risk of breakthrough infections in vaccinated individuals at high risk of exposure such as healthcare personnel (HCP). A systematic literature review (SLR) applying the PRISMA declaration and the PECOS format using the following entry terms was used: “Health Personnel OR Healthcare Worker OR Healthcare Provider OR Healthcare Personnel AND breakthrough OR infection after vaccine*”. The research was carried out utilizing the following databases: SCOPUS, PubMed, Embase, and Web of Sciences. An overall very low incidence of post-vaccination breakthrough infections was found, ranging from 0.011 to 0.001 (per 100 individuals at risk). Our findings further support the published high effectiveness rates of mRNA vaccines in preventing SARS-CoV-2 infections among fully vaccinated HCP. Additional studies are needed to define the duration of the vaccine-induced protection among HCP.

Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination During Pregnancy, Pregnancy Risk Assessment Monitoring System, 2019

Background Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines is recommended for pregnant women to protect themselves and their infants from adverse health outcomes. Objectives To estimate the prevalence of maternal influenza and Tdap vaccination and determine factors associated with receipt of these vaccines. Methods We analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System, from 43 jurisdictions. We estimated the overall prevalence of women reporting receipt of a healthcare provider offer or recommendation for influenza vaccine (n=44,528), and influenza vaccine during the 12 months before delivery (n=44,213). We also estimated Tdap vaccine receipt during pregnancy from the 21 jurisdictions (n=22,972). Maternal influenza and Tdap vaccination were examined by selected maternal characteristics and by jurisdiction. Results Overall, 86.4% of women reported being offered or recommended an influenza vaccination, and 60.8% of women reported receiving an influenza vaccination in the 12 months prior to their delivery, ranging from 36.0% in Puerto Rico to 82.1% in Rhode Island. Tdap receipt during pregnancy was 73.7%, ranging from 52.2% in Mississippi to 85.1% in Vermont. Prevalence of influenza vaccination was lower among women aged 18–24 years (52.2%), who are non-Hispanic black (44.5%), with a high school diploma or less education (51.3%), with no prenatal insurance (43.2%), having no (42.0%) prenatal care, with ≥3 previous live births (49.3%) and not offered or recommended the influenza vaccine by a healthcare provider (20.0%). Tdap vaccination also varied by all characteristics examined and was lower among similar groups of women observed to have lower influenza vaccination uptake. Conclusion In 2019, influenza and Tdap vaccination were suboptimal among women with a recent live birth. It is important that U.S. jurisdictions provide equitable access to these vaccines during pregnancy. These results may also inform efforts for vaccination for other infectious diseases among pregnant women.

A model for incorporating faith, values, and ethics into a healthcare provider course

Faith, values, and ethics are critical for all individuals to learn, but especially healthcare providers. Here, we report on the development of a course focused on these topics at a private Christian college of pharmacy. The course utilized a longitudinal approach combined with three overarching and connected course themes to explore the merging of faith and professional practice. Students were engaged in learning using a combination of approaches including guest presenters, panel discussions, interactive interviews, and small group discussions. This course provides a model for discussing faith, values, and ethics in the context of healthcare education.

Securing an IoT Medical System Using AI and a Unidirectional Network Device: Application to a Driver

Security in systems and networks has always been a major issue for IT administrators. When it comes to medical applications, this concern is much more important due to the sensitivity of data and the risks that may be caused due to alteration or falsification of such critical information. The proposed paper presents a solution to assure the best security possible in such an environment. Thus, based on an application that monitors a driver’s health while driving his car, a data diode will be implemented in order to assure security of the system by forcing unidirectional flow of network data to the healthcare provider side. Added to that, an AI-based program will be developed to verify the confidentiality, the integrity and the availability of the exchanged data and to check the patient health for abnormalities. Every sub-part of the system has been tested separately and results have shown that falsified data has been filtered out of the received end, e.g. the healthcare provider side.

COVID-19 triage in general adult in-patient psychiatry: perspectives from clinicians on a novel triage ward during the pandemic

SUMMARY Intra-hospital transmission of COVID-19 is a major concern. To mitigate this risk, ‘COVID-triage’ psychiatric wards were implemented by some in-patient service providers in the UK. Although the effectiveness of this model has not been investigated, there are questions about the benefits and detriments of this model of care for patients and staff. This reflection draws from the experiences of clinicians who were redeployed from their planned clinical posts (and training rotations, in the case of trainees) to staff a newly established COVID-triage ward at a large urban mental healthcare provider, between August 2020 and March 2021.

Fears of disclosure and misconceptions regarding domestic violence reporting amongst patients in two US emergency departments

Patients often do not disclose domestic violence (DV) to healthcare providers in emergency departments and other healthcare settings. Barriers to disclosure may include fears and misconceptions about whether, and under what circumstances, healthcare providers report DV to law enforcement and immigration authorities. We sought to assess undocumented Latino immigrants (UDLI), Latino legal residents/citizens (LLRC) and non-Latino legal residents/citizens (NLRC) beliefs about disclosure of DV victimization to healthcare providers and healthcare provider reporting of DV to law enforcement and immigration authorities. From 10/2018-2/2020, we conducted this survey study at two urban emergency departments (EDs) in California. Participants, enrolled by convenience sampling, responded to survey questions adapted from a previously published survey instrument that was developed to assess undocumented immigrant fears of accessing ED care. Our primary outcomes were the proportions of UDLI, LLRC and NLRC who knew of someone who had experienced DV in the past year, whether these DV victims were afraid to access ED care, reasons DV victims were afraid to access ED care, and rates of misconceptions (defined according to current California law) about the consequences of disclosing DV to healthcare providers. Of 667 patients approached, 531 (80%) agreed to participate: 32% UDLI, 33% LLRC, and 35% NLRC. Of the 27.5% of respondents who knew someone who experienced DV in the past year, 46% stated that the DV victim was afraid to seek ED care; there was no significant difference in this rate between groups. The most common fears reported as barriers to disclosure were fear the doctor would report DV to police (31%) and fear that the person perpetrating DV would find out about the disclosure (30.3%). Contrary to our hypothesis, UDLI had lower rates of misconceptions about healthcare provider and law enforcement responses to DV disclosure than LLRC and NLRC. Fear of disclosing DV and misconceptions about the consequences of disclosure of DV to healthcare providers were common, indicating a need for provider, patient, and community education and changes that lower barriers to help-seeking.

Aging through the time of COVID-19: a survey of self-reported healthcare access

Background Chronic conditions are common and require ongoing continuous management and preventive measures. The COVID-19 pandemic may have affected the management of chronic conditions by delaying care. We sought to understand the impact of personal characteristics (i.e., age) and healthcare factors (i.e., access to a provider) on healthcare access in a sample of Americans 50 years of age or older during COVID-19. Method Participants completed an online survey at the start of the COVID-19 pandemic – the Aging in the Time of COVID Survey. Questions focused on health status, health care access, COVID-19 fear, and social connectedness. Participants were recruited through social media advertisements, list serves, and snowball sampling. Data collection started in early April 2020 and concluded in late May 2020. Logistic regression models examined the results of two key access points: healthcare provider/doctor (n = 481) and medication (n = 765), with 56 and 93% of participants reporting access to a provider and medications, respectively. Results Individuals with an established primary care provider were much more likely to obtain access to a healthcare provider, OR = 3.81 (95% CI: 1.69, 8.77), and to receive medication, OR = 4.48 (95% CI: 1.61, 11.48), during the time of COVID-19. In addition, access to medication was (a) higher for those who were older, OR = 1.05 (95% CI: 1.01, 1.09), had a higher income (greater than 100 k compared to less than 50 k, OR = 3.04 (95% CI: 1.11, 8.98), and (b) lower for those having caregiving responsibilities, OR = 0.41 (95% CI: 0.21, 0.78), or greater social isolation, OR = 0.93 (95% CI: 0.87, 0.98). Conclusions Although most participants had access to medication, just over half had access to a healthcare provider when needed. Notably, health-seeking behaviors for individuals who do not have an established primary care providers as well as those who provide unpaid care, are socially isolated, and younger may require more proactive approaches to care monitoring, management, and maintenance.

Health Care System Decentralization Via Uberization, Concepts and Expected Efficiency Outcomes

Background:According to statistical studies, about 3.6 million Americans miss medical appointments each year because of difficulties with transportation to a healthcare facility, and the impact of missed primary care appointments is estimated at billions of dollars annually. The access of the patient to necessary services is restricted and the role and functions of a medical doctor as responsible key decision maker is significantly diminished. Key responsibilities are still on the shoulders of the medical doctor, but decision-making power is shifted to middleman administrative bodies. This split between the responsibilities and decision-making bodies is destructive for the service of medicine. The aim of this study is to create a new management model in the health care system.Methods: To develop a new model of management in the health care system, we conducted a blind survey among 1,700 patients. To optimize the health care system, a decentralization health careservice method is proposed via uberization.Results: The method may continue with providing the request to a responding healthcare provider and receiving a response from the responding healthcare provider. The method may continue with establishing a bidirectional communication between the patient and the responding healthcare provider in real-time and receiving a plan of actions to treat the patient from the responding healthcare provider. The method may continue with receiving, from the diagnostic and laboratory service, the real-time vital parameters of the patient and making the real-time vital parameters available to the patient and the responding healthcare provider in an electronic medical record database.Conclusion: On the basis of our developed model of decentralization of the healthcare system via uberization, the implementation of the proposed model will increase the efficiency and availability of medical services.